Racism’s Threat to Public Health
Our Race to Health columnist, Kenrya Rankin, talks to public health expert Dr. Regina Davis Moss about how racism impacts health.
It’s no secret that 2020 has been a time of upheaval for the United States, as we simultaneously reckon with the COVID-19 pandemic and the centuries old epidemic of systemic racism. One outcome of the fight is the growing recognition by policymakers and residents alike that there is a major overlap between the systems that breed discrimination and the ones that breed chronic health conditions. To that end, cities and entire states have increasingly made formal declarations that acknowledge that racism itself is a public health crisis. On the federal level, a group of congressional representatives and senators recently introduced the Anti-Racism in Public Health Act of 2020, which seeks to increase research and investment around the public health impact of structural racism and obligate the federal government to develop an anti-racist health policy.
“For far too long, our federal government has failed to recognize and address the structural racism that has devastated Black and Brown communities and denied access to quality health care,” Congressional Representative Ayanna Pressley (D-MA) said in a statement. “With the COVID-19 pandemic unveiling and exacerbating racial disparities in health outcomes, it is time we recognize and treat structural racism and police brutality as the public health crises that they are. We must have a coordinated public health response to structural racism, and this bill would do just that.”
We sat down with Regina Davis Moss, associate executive director of public health policy and practice at the American Public Health Association in Washington, D.C., to get a fuller picture of this phenomenon.
Kenrya Rankin: Why is racism a public health crisis?
Regina Davis Moss: The impact of racism on health has long been proven and was outlined in the 1985 Heckler Report, which provided evidence of inequalities in infant mortality, cancer, strokes, and other health outcomes. Whether through force, deprivation or discrimination, racism severely impacts health.
When public health talks about the intersection of racism and health, most think of interpersonal racism, which is overt prejudice or acts of bias between individuals. However, we’re talking about the historic and ongoing institutional forces that dictate access to health-promoting resources and opportunities. This is what drives health disparities and creates barriers to living our healthiest lives.
We should all absolutely be physically active most days of the week and eat a diet rich in grains, fruits, and vegetables. But it becomes harder to prioritize this when you don’t feel safe in your neighborhood or aren’t paid a living wage and can’t afford to buy healthy food to eat. Also, racism goes beyond socioeconomic status. Black women in the U.S. are almost almost four times more likely to die from pregnancy-related causes than White women. This inequity is seen among Black women who have college degrees .
Put simply, the definition of a public health threat or epidemic is an external agent that causes disease, injury, or other poor health conditions to occur more than expected among specific groups during a specific period. Racism is an external agent.
KR: What chronic conditions are we talking about when we talk about racism and the people it negatively impacts?
RDM: Numerous studies have found racism to be associated with unhealthy changes to key biologic systems (e.g. metabolic, immune systems, cardiovascular, etc.), which take their toll on the bodies of people of communities of color over time. Repeated exposure to racial prejudice and discrimination results in adverse mental and physical health effects such as chronic stress, high blood pressure, heart disease, cancer, diabetes and asthma.
KR: I know that the American Public Health Association keeps a running tally of the states and municipalities that have declared racism a public health crisis or emergency. Why do you think so many municipalities are tackling this now?
RDM: There are well over 100 agencies, states, cities and municipalities that have formally and informally declared racism a public health threat or crisis and the list is growing. Racism is a driving force of social determinants of health (e.g. housing, education and employment) and is the root cause of the different outcomes we see in people of color. Acknowledging it as a threat, emergency, or crisis stresses the urgency in addressing these outcomes with a rapid response. It can also be a statement about the state’s or municipality’s commitment to create a more equitable community. Declaring racism a public health concern also offers legislators, health officials and others a way to analyze data and discuss how to dismantle problematic institutions. The acknowledgment can also serve as a basis for allocation or reallocation of resources that support anti-racism and racial equity efforts.
KR: What is the significance—and usefulness—of these types of declarations?
RDM: While these statements are significant, what will ultimately distinguish these declarations as either effective or purely symbolic will depend on whether they are followed with increased funding and concrete actions.
KR: What needs to happen next? How do we move beyond declarations to action?
RDM: We need public investments that will enable all state residents to realize their full potential. That includes increasing K-12 education budgets so students attending schools in under-resourced communities have the best chance at educational success; providing economic resources and support so struggling families have secure income, housing and healthy food; ensuring access to quality, patient-centered health care and early childhood programs to buffer children from being adversely affected; affordable college for all who want to pursue higher learning, and efforts to generate a more robust workforce. These kind of investments help create opportunities for people who are situated differently across structures of society, particularly communities of color.
RDM: The Anti-Racism in Public Health Act is a bill that would formally identify systemic racism as a public health crisis in the United States. It would also establish a Center on Anti-Racism in Health within the CDC and create programs within the Center for Injury Prevention and Control focused on preventing violence by law enforcement.
I am hopeful that it will move the needle, but we don’t have to wait to begin developing anti-racist health policies. We are already doing some of the work when we use approaches like health and equity in all policies. Most important, the federal government should protect public health leadership so we can have a coordinated response and protect the nation without threats or pushback.
KR: What does success in this area look like to you?
RDM: Success is acknowledging that racism exists and that there is a connection to health, holding those who commit racist crimes and acts accountable, and carrying out sustained action across a variety of sectors, programs and policies.
- Heckler Report: Heckler, Margaret. (1985). “Report of the Secretary's Task Force on Black & Minority Health.” collections.nlm.nih.gov/catalog/nlm:nlmuid-8602912-mvset
- Black Maternal Mortality: Centers for Disease Control and Prevention. (2019). “Racial and Ethnic Disparities Continue in Pregnancy-Related Deaths.” cdc.gov/media/releases/2019/p0905-racial-ethnic-disparities-pregnancy-deaths.html
- Racism and Metabolic Syndrome: Psychosomatic Medicine. (2020). “Everyday Discrimination and Metabolic Syndrome Incidence in a Racially/Ethnically Diverse Sample: Study of Women’s Health Across the Nation (SWAN).” ncbi.nlm.nih.gov/pmc/articles/PMC5741524/
- Racism and Immune System: Journal of Adolescent Health. (2015). “Discrimination, Racial Identity, and Cytokine Levels Among African American Adolescents.” ncbi.nlm.nih.gov/pmc/articles/PMC4409660/
- Anti-Racism in Public Health Act (1): Pressley, Ayanna. (2020). “Pressley, Warren, Lee Introduce Legislation to Confront the Public Health Impacts of Structural Racism.” pressley.house.gov/media/press-releases/pressley-warren-lee-introduce-legislation-confront-public-health-impacts
- Anti-Racism in Public Health Act (2): Pressley, Aynna. (2020). “Anti-Racism in Public Health Act: Anti-Racism in Public Health Act of 2020.” pressley.house.gov/sites/pressley.house.gov/files/Anti-Racism%20in%20Public%20Health%20Act%20bill%20text.pdf